The present invention relates to apparatus and methods for effecting hemostasis in an organ and, more particularly, to such apparatus and method useful in effecting hemostasis in a parenchymal organ such as the spleen or liver.
In an article entitled in English "Treatment Of Lesions of Parenchymatous Organs--Original Technique" originally published in Italy in 1986 under the title "Trattamento Delle Lesioni Degli Organi Parenchimatosi--Technica Originale" Relazione 87.degree. Congr. della Societa Italiana di Chirurgia--Torino 1986 and abstracted in the Italian language publication Journal of Surgery, Vol. VII, No. 3 (March, 1986), Aglietti et al. disclose a technique for effecting hemostasis in a parenchymal organ such as the liver. The disclosed technique involves the use of a bioabsorbable, flat, single layer mesh which is manually conformed to the bleeding surface of the liver and a suction-applying cup which is placed over the mesh and the bleeding surface and manually maintained there until homorrhaging terminates.
The Agletti mesh is formed of a bioabsorbable material such as chromic catgut and is provided in rectangles or other shapes approximately 5.times.10 cm in area. The mesh is woven in a plain "left and right" weave and is therefore a flat monolayer. Typically each square centimeter utilizes about 10 cm of thread and is 4-5 millimeter thick, each interstice of the mesh being about 2 mm.sup.2. The mesh provides a matrix of openings or interstices through which portions or fingers of the bleeding surface may be pulled, with the resulting infiltrating liver fingers being aligned generally parallel to one another. The suction, vacuum or negative pressure applied by the cup causes the parenchymal tissue to infiltrate the interstices or openings of the gridlike weave of he mesh. As soon as hemostasis is achieved, the cup is removed from the mesh and the previously bleeding surface, with the mesh being left imbedded in the parenchymal organ. In practice the Agletti technique has not proven to be entirely satisfactory.
An important disadvantage of the Aglietti technique is the time that must be wasted while the surgeon holds the suction cup over the mesh of the bleeding surface until achievement of hemostasis. The normally strong blood flow to the parenchymal organ supports and extends hemorrhaging at bleeding surface by feeding additional blood to that surface. Further, as the cup must be held in place by the surgeon or his assistants until bleeding of the surface has been effectively terminated (as evidenced by the end of blood flow out of the cup), precious minutes may be wasted during which the surgeon's attention might be profitably directed elsewhere, especially where the trauma to the liver also affected other organs. In some instances complete hemostasis is not achieved for hours, and thus the patient must be left on the operating table for a prolonged period of time.
A further disadvantage of the Aglietti technique is that the portions of the parenchymal organ which infiltrate the interstices of the mesh are in a parallel orientation to one another. While the portions which have infiltrated and passed through to the other side of the mesh typically expand and join to some degree on such other side of the mesh, thereby promoting healing of the organ, there is no positive mechanical influence biasing such portions together so as to positively promote healing.
Accordingly, it is an object of the present invention to provide apparatus which accelerates the effecting of hemostasis by decreasing the blood flow to the organ being treated.
Another object is to provide such apparatus which positively promotes the joinder of the organ portions infiltrating the mesh.
A further object is to provide such apparatus which reduces or eliminates the time during which the surgeon must manually maintain the suction cup over the mesh on the bleeding surface.
It is also an object of the present invention to provide such apparatus which, in one embodiment, permits the incision to be closed and the patient removed from the operating table while suction is still being applied to the bleeding surface and mesh.
It is another object to provide a method of using such apparatus.